Retinal Artery Occlusion Follow-up
- Author: Benjamin Feldman, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
Further Outpatient Care
Patients should have serial evaluation of visual acuity by an ophthalmologist.
An ophthalmologist should perform evaluation for subsequent neovascularization of the iris or retina.
If HBO is to be used, several treatments may be necessary.
Patients require urgent follow up for carotid and cardiac evaluation to preclude further central retinal artery occlusion (CRAO) or stroke.
Further Inpatient Care
Further inpatient care is indicated only if comorbid disease is present.
Inpatient & Outpatient Medications
Inpatient or outpatient medications are indicated only if comorbid disease is present.
Transfer to a hyperbaric facility is necessary if hyperbaric oxygen is to be administered.
Patients should keep their blood pressure under control, lower their cholesterol, avoid IV drugs, and take their medication.
Further emboli to brain resulting in CVA
Further emboli to the same or contralateral eye, resulting in further visual loss
Progression of temporal arteritis, resulting in loss of vision to the contralateral eye
Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity.
Studies report that 21% of patients exhibited visual improvement of 6 gradients of visual acuity, 35% exhibited improvement of 3 gradients of visual acuity, while 26% showed no improvement in visual acuity.
Patients that showed improvement had presenting visual acuity of counting fingers and a mean duration of visual loss of 21.1 hours; those that did not improve had presenting visual acuity of hand movement and a mean duration of visual loss of 58.6 hours.
The longest delay to treatment that has been associated with significant visual recovery is approximately 72 hours.
Presence of a cilioretinal artery with foveolar sparing increases improvement of visual acuity.
Branch retinal artery occlusions (BRAOs) are associated with a higher recovery rate (80% of eyes improve to 20/40 or better) than central retinal artery occlusions (CRAOs).
Patients must understand that the prognosis for visual recovery is poor and that the visual changes are usually a result of a systemic process that needs treatment.
Youm DJ, Ha MM, Chang Y, Song SJ. Retinal vessel caliber and risk factors for branch retinal vein occlusion. Curr Eye Res. 2012 Apr. 37(4):334-8. [Medline].
Klein R, Klein BE, Moss SE, Meuer SM. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Arch Ophthalmol. 2003 Oct. 121(10):1446-51. [Medline].
Ratra D, Dhupper M. Retinal arterial occlusions in the young: Systemic associations in Indian population. Indian J Ophthalmol. 2012 Mar. 60(2):95-100. [Medline].
Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007 Sep. 27(3):215-30. [Medline].
Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B. Early hyperbaric oxygen therapy for retinal artery occlusion. Eur J Ophthalmol. 2001 Oct-Dec. 11(4):345-50. [Medline].
Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. 2008 Nov. 146(5):700-6. [Medline].
Nowak RJ, Amin H, Robeson K, Schindler JL. Acute Central Retinal Artery Occlusion Treated with Intravenous Recombinant Tissue Plasminogen Activator. J Stroke Cerebrovasc Dis. 2012 Feb 18. [Medline].
Cohen JE, Moscovici S, Halpert M, Itshayek E. Selective thrombolysis performed through meningo-ophthalmic artery in central retinal artery occlusion. J Clin Neurosci. 2012 Mar. 19(3):462-4. [Medline].
Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion. Ophthalmology. 1995 Dec. 102(12):2029-34; discussion 2034-5. [Medline].
Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol. 1980 Dec. 64(12):913-7. [Medline].
Beiran I, Reissman P, Scharf J, et al. Hyperbaric oxygenation combined with nifedipine treatment for recent-onset retinal artery occlusion. Eur J Ophthalmol. 1993 Apr-Jun. 3(2):89-94. [Medline].
Brown GC. Retinal artery obstructive disease. Ryan SJ, ed. Retina. St. Louis: Mosby; 1994. Vol 2: 1361-77.
Brown GC, Magargal LE, Shields JA, et al. Retinal arterial obstruction in children and young adults. Ophthalmology. 1981 Jan. 88(1):18-25. [Medline].
Butz B, Strotzer M, Manke C, et al. Selective intraarterial fibrinolysis of acute central retinal artery occlusion. Acta Radiol. 2003 Nov. 44(6):680-4. [Medline].
Cella W, Avila M. Optical coherence tomography as a means of evaluating acute ischaemic retinopathy in branch retinal artery occlusion. Acta Ophthalmol Scand. 2007 Nov. 85(7):799-801. [Medline].
Ffytche TJ, Bulpitt CJ, Kohner EM, et al. Effect of changes in intraocular pressure on the retinal microcirculation. Br J Ophthalmol. 1974 May. 58(5):514-22. [Medline].
Fraser S, Siriwardena D. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev. 2002. CD001989. [Medline].
Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology. 1980 Jan. 87(1):75-8. [Medline].
Hertzog LM, Meyer GW, Carson S, et al. Central retinal artery occlusion treated with hyperbaric oxygen. J Hyperbaric Med. 1992. 7:33-42.
Knoop K, Trott A. Ophthalmologic procedures in the emergency department--Part I: Immediate sight-saving procedures. Acad Emerg Med. 1994 Jul-Aug. 1(4):408-12. [Medline].
Lacy C, Armstrong LL, Ingram N, et al. Drug Information Handbook. 4th ed. Hudson, Cleveland: Lexi-Comp Inc; 1996.
Magargal LE, Goldberg RE. Anterior chamber paracentesis in the management of acute nonarteritic central retinal artery occlusion. Surg Forum. 1977. 28:518-21. [Medline].
Mangat HS. Retinal artery occlusion. Surv Ophthalmol. 1995 Sep-Oct. 40(2):145-56. [Medline].
Mead GE, Lewis SC, Wardlaw JM, Dennis MS. Comparison of risk factors in patients with transient and prolonged eye and brain ischemic syndromes. Stroke. 2002 Oct. 33(10):2383-90. [Medline].
Miyake Y, Horiguchi M, Matsuura M, et al. Hyperbaric oxygen therapy in 72 eyes with retinal arterial occlusion. 9th International Symposium on Underwater and Hyperbaric Physiology. 1987. 949-53.
Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol. 2003 Jun. 14(3):139-41. [Medline].
Schmidt D, Schumacher M, Wakhloo AK. Microcatheter urokinase infusion in central retinal artery occlusion. Am J Ophthalmol. 1992 Apr 15. 113(4):429-34. [Medline].
Schmidt DP, Schulte-Monting J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol. 2002 Sep. 23(8):1301-7. [Medline].
Suri MF, Nasar A, Hussein HM, Divani AA, Qureshi AI. Intra-arterial thrombolysis for central retinal artery occlusion in United States: Nationwide In-patient Survey 2001-2003. J Neuroimaging. 2007 Oct. 17(4):339-43. [Medline].
Wray SH. The management of acute visual failure. J Neurol Neurosurg Psychiatry. 1993 Mar. 56(3):234-40. [Medline].